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May 26, 2026Open Access

Prevalence, morphology, and management of coronary cameral fistulas detected on cardiac CT: a multicenter study

Key Points

This study aims to evaluate the prevalence, morphology, and clinical outcomes of coronary cameral fistulas detected via cardiac CT.
Retrospective review of 22,641 patients undergoing cardiac CT from January 2012 to July 2025.
Two radiologists independently assessed CCF morphology including origin vessel and fistula diameter.
Clinical data were collected from electronic medical records, analyzing 15 cases of CCF.
CCFs were found in 15 patients (prevalence of 0.07%).
50% of patients were symptomatic at diagnosis; right coronary artery was the most common origin (42.9%).
No CCF-related adverse cardiac events occurred during 19-month median follow-up.

Abstract

This study aimed to assess the prevalence, morphology, and clinical outcomes of coronary cameral fistulas (CCFs) detected on cardiac computed tomography (CT) at three tertiary centers. We retrospectively reviewed 22,641 patients who underwent cardiac CT between January 2012 and July 2025. The CCF cases were identified through a PACS search. Two radiologists independently assessed the origin vessel, drainage site, fistula number, and diameter. The clinical data was obtained from electronic medical records. The CCFs were identified in 15 patients; 14 were analyzed after excluding one patient who lacked preoperative imaging. Seven (50.0%) patients were symptomatic at diagnosis. Two (14.3%) patients had dual coronary origins, totaling 16 origin vessels. Of the 16 origin vessels, the right coronary artery was the most common (n = 6, 42.9%). The drainage sites included the left ventricle (35.7%), right atrium (28.6%), right ventricle (21.4%), and left atrium (14.3%). The median maximal fistula diameter was 4.2 mm; the surgical patients (n = 4, 28.6%) had significantly larger fistulas. During a 19-month median follow-up, no CCF-related adverse cardiac events occurred. The CCFs are rare anomalies identified on CCTA (prevalence of 0.07%). Surgical patients had larger fistula dimensions than conservatively managed patients, and no CCF-related adverse cardiac events occurred during midterm follow-up.

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